Moscarelli Marco, Punjabi Prakash P, Miroslav Gamov I, Del Sarto Paolo, Fiorentino Francesca, Angelini Gianni D
NHLI, Hammersmith Hospital, Imperial College London, London, UK.
Fondazione Monasterio, Ospedale Pasquinucci, Massa, Italy.
J Cardiothorac Surg. 2015 Jan 20;10:7. doi: 10.1186/s13019-014-0204-7.
Off-pump coronary artery bypass surgery by avoiding cardioplegic arrest seems to reduce the risk of ischemic myocardial injury. However, even short-term regional ischemic periods, hemodynamic instability and arrhythmias associated with the procedure can be responsible for myocardial damage. Conditioning, a potential cardio-protective tool during on-pump cardiac surgery, has hardly been investigated in the context of off-pump surgery. There are virtually no large trials on remote ischemic preconditioning and the majority of reports have focused on central ischemic conditioning. Similarly, volatile anesthetic agents with conditioning effect like ischemic preconditioning have been shown to reduce cardiac injury during on-pump procedures but have not been validated in the off-pump scenario. Here, we review the available evidence on myocardial conditioning, either with ischemia/reperfusion or volatile anesthetic agents in patients undergoing off-pump coronary artery surgery.
非体外循环冠状动脉搭桥手术通过避免心脏停搏似乎能降低缺血性心肌损伤的风险。然而，即使是短期的局部缺血期，与该手术相关的血流动力学不稳定和心律失常也可能导致心肌损伤。预处理作为体外循环心脏手术期间一种潜在的心脏保护手段，在非体外循环手术的背景下几乎未得到研究。实际上，几乎没有关于远程缺血预处理的大型试验，大多数报告都集中在中枢缺血预处理上。同样，具有类似缺血预处理调节作用的挥发性麻醉剂已被证明可减少体外循环手术期间的心脏损伤，但尚未在非体外循环情况下得到验证。在此，我们回顾了关于接受非体外循环冠状动脉手术患者使用缺血/再灌注或挥发性麻醉剂进行心肌预处理的现有证据。
